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48 Cards in this Set

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Differs from major dep in severity and duration; represents a chronic mild depressive cond for many yrs. Must for over 2 yrs exhibit a dep mood for most of the day on most days.
Unipolar disorders
[Along w/ dysthymia, rather two aspects of same disorder if present in same person]
Symptoms must not be absent for more than 2 months at a time during the 2 yr per. If at any time during the first 2 yrs the patient meets criteria for maj dep episode, the diag would be that vs dysthymia.
Hypomania vs bipolar II
-Episodes of inc energy that are not sufficiently severe. - A person w/ at least one major dep episode, at least one hypomanic episode, and no full blown manic episode.
Bipolar disorders
- Symptoms must be present for a min of 4 days to meet threshold for a hypomanic episode (vs 1 wk for manic episode). The mood change must not be severe enough to impair social or occup func.
[DSM IV has two more considerations: episode specifiers-specific symptoms present. Course specifiers: pattern disorder follows.]
In DSM IV: a chronic but less severe bipolar disorder. A person must exp numerous hypomanic episodes and numerous per of dep during a per of 2 yrs. Must be no hist of major dep episodes and no clear evidence of manic episode during first 2 yrs.
First episode usu in mid 40s. 10% had dep episodes for longer than 2 yrs. Most patients have at least 2 dep episodes and the mean lifetime episodes is 5 or 6. Approx half recover w/in 6 months; 10-20 do not after 5 yrs. Half relapse within 3 yrs.
Bipolar disorder
Usu btwn 28-33 yrs. Manic episodes usu 2-3 months. After 10 yrs; 40-50% recovered.
ECA study
Approx 6% had a mood disorder during 6 months. Lifetime risk for dsthymia is 3% and bipolar I 1%. Half with criteria for dsthymia also had one episode of major dep. 30% sought help. Women are 2 or 3 times more vuln.
-Depressogenic attributional style
-Depressive triad (self,world,future)
- Int, stable, global.
Biological factors
- Risk for bipolar disorder among close relatives is close to from general popul but unipolar is double.
- People homozygous for the "s" allele of 5-HTT gene are at high risk for becoming dep.
-HPA: pathway in endocrine sys closely related to etiology of mood disorders.
- Cushing's syndrome: adrenal glands with high cortisol. - Abnormal patters of activation in PFCortex; glucose in amygdala. - SSRIs inhibit reuptake of 5-HT, AGO; sideeffects: sexual dysfunc and weight gain. - 40% of bipolar patients do not improve w/ lithium, compliance.
- White males over 50; half due to a mood disorder. - Durkheim: Egoistic suicde (detached), Altruistic (sacrifice), Anomic (breakdown in soc order, polit/econ crisis), Fatalistic (unbearable life circumstances). More than 30,000 people in US kill themselves per yr. Schneidman: escape from psy pain. Serotonin dysfun link. to dep. Suicide linked to genetics/violent beh. Relig affil?
Depression is a Syndrome
[Top ten cause of death]
Syndrome = cluster of symptoms
When does feeling down become clinical depression?
Diagnosis requires either
Depressed mood
Diminished interest/pleasure in activities
Depression without insight ??
-Midnight insomnia. Dep generally sleeping too much.
- Dysthymia: chronic lower level; place holder for endogenous? Maj dep a placeholder for exogenous?
Mood Disorder Subtypes
[Bipolar: anger is dep inward? but categ as manic... Difficult to force patients to take medic]
Major depressive disorder (DSM)
Dysthymia (DSM)
Exogenous (precipitated) versus endogenous (internally caused) ??
Seasonal affective disorder ??
Melancholia ??
Remember general paresis history (Chap 2)
This (hopefully) is future for mood disorders
The future is unlikely to be based on description, the core classification assumption of the current DSM
Is grief (sometimes) a model for depression?
What is grief?
Stages of grief? (Kubler Ross)
Denial, anger, bargaining, depression, acceptance
Can grief be pathological?
Do we grieve differently for potentially revocable losses?
- Divorce: no one to grieve with. Really over?
Theory of Grieving in Cycles Not stages
-Grieving Loss of Romantic Relationships
- Virginia Dating Study
Analogue studies – see Research Methods Chapter 5
Virginia Dissolution Study
Prospective research
Random sampling of mood ratings
Experience sampling method
-The leaver (guilt, responsibiility, righteousness) - left (rejection, hope, hurt/pain)
Causes of Depression
Childhood origins of cognitive errors?
Interpersonal/emotional – humans are social animals
Other situations when abnormal sadness is normal?
Genetic, especially bipolar
Hard to know how much is genetic with poor diagnosis
Genetic linkage studies
Neuroendocrine – cortisol (the stress hormone)
Neurotransmitters – but not necessarily a “chemical imbalance”
Brain imaging
Empirically Supported Treatments
Cognitive behavior therapy (CBT)
Beck’s cognitive therapy
Behavioral activation (newer)
Interpersonal therapy
Roots in client centered (Rogers), psychodynamic, and family systems approaches
A contextualized behavior therapy approach?
One that puts emotion first
Empirically Supported Treatments
Antidepressant medications
SSRIs (selective serotonin reuptake inhibitors)
-Prevents reuptake of serotonin
- Inhibits reuptake of several neurotransmitters
MAO inhibitors
- Prevents breakdown of several neurotransmitters
Atypical antidepressants
Debate about which of 3 treatments is better
Real issue is long-term effectiveness of all 3
Treatment of Depression: Collaborative Research Program
Cognitive behavior therapy vs. interpersonal therapy vs. imipramine (a tricyclic) vs. placebo
First major randomized clinical trial
250 patients, 3 major sites
Rival advocates of CBT, IPT
Remember the allegiance effect?
All treatments significantly outperformed placebo
Recovery rates: Medication 57%; IPT 55%; CBT 51%; Placebo 29%
CBT and IPT not significantly different
Medication more effective with more severe depression
Substantial placebo effect
Treatment of Depression: Collaborative Research Program
Relapse rates about those who recovered
36% CBT
33% IPT
50% imipramine
33% placebo
No significant differences
Depression is cyclical
Over time
Emotion-cognition-behavior cycle
Continue medication indefinitely?
Periodic therapy sessions?
Specific, realistic, present, adaptive
General, out of proportion, future, often maladaptive
Panic attack
Sudden, overwhelming terror
Irrational, focused anxiety
Not true phobia; defined by narrow safety zone not phobic avoidance
Freudian term for unconscious (id-ego) conflict; once a major basis for DSM classification
One anxiety (lumpers) or many anxieties (splitters)
Evolution – anxiety is adaptive
Specific fears – strangers, height, snakes
Separation anxiety (throughout the life span; stay close to the herd…)
Social fears
Public speaking, stress dreams
Panic attack – suffocation alarm? extreme fight/flight?
Obsessions and compulsions – children? Adaptive…
Fight or flight (or freeze)
Fear of the unknown
Threat monitoring (rabbits versus cats)
Uptight and laid back monkeys
Disorder = extreme individual variation on species typical behavior
Then there is fear of fear, guilt, existential anxiety, angst
Emery (Panksepp) – emotion systems
Anxiety Disorders
Specific phobia
Social phobia
Panic disorder
Obsessive-compulsive disorder
Generalized anxiety disorder
(Posttraumatic stress disorder: classified as an anxiety disorder for now)
Frequency and Cause
Similarity to depression
Are anxiety and depression really the same thing?
Negative affect
I don’t think affect is that simple
Exposure – face your fears (get back on the bicycle)
Antianxiety drugs – short-term, addictive
“Antidepressants” – help with anxiety too
Classification note: ASD, PTSD surely will be classified as:
2) Conscious and Unconscious
“stress related disorders” in DSM V
2) There are unconscious mental processes. Are they?
Minor (e.g., don’t know how we remember)
Major (e.g., Freud’s idea of the unconscious)
The disruption in normally integrated processes in memory, consciousness, memory, or perception
Numbing, detachment
Reduced awareness
Hypnosis – state like absorption in good movie
Dissociative amnesia
How BIG is Dissociation?
PTSD – no doubt
Dissociation is a maladaptive sign not an adaptive psychological defense
Dissociative Identity Disorder (Multiple Personality)
Eve, Sybil, Kenneth Bianchi
Child sex abuse
Satanic Ritual Abuse– Remembering Satan by Lawrence Wright
Enthusiast: http: //
Moderate?: http: //
Skeptic: http: //
A threat involving actual or threatened death or serious injury to self or others that creates feelings of horror
Outside the range of human experience? (So said earlier DSM)
Symptoms of ASD and PTSD
ASD (2 days to 4 weeks)
Where were you on 9/11? (Flashbulb memories)
Experience dissociation?
Plus PTSD symptoms
Reexperiencing – e.g., flashbacks
Avoidance and numbing – e.g., “emotional anesthesia”
Arousal and anxiety – e.g., exaggerated startle response
Case of “Stephanie”
Trauma is necessary but not sufficient
Nature of trauma
Level of exposure
Social support
MZ twins discordant for combat
PTSD 9 times higher for those in combat
Trauma and PTSD are not random
Gene-environment correlation, e.g., antisocial behavior
MZ twins higher concordance following combat than DZ twins
Biological effects of trauma exposure? – critical thinking
Hippocampus volume smaller (involved in memory)
Unaffected co-twins also have smaller hippocampus volume
Critical incident stress debriefing or EMDR
Critical thinking
Therapeutic reexposure/emotional processing
Somatoform Disorders?
Something to somatization
10 year old giving a piano concert
Less psychological sophisticated cultures?
Clear problem in medical treatment settings
Henry video
Perils of diagnosis by exclusion
Freud’s “hysterias”
Undiagnosed, unusual medical conditions
According to the two-factor theory:
Classical cond creates fear when terror from trauma is paired w/ cues assoc w/ the traumatic event. Operant cond maintains the fears. (Avoidance is neg rein by reduc in anxiety). Emot processing and meaning making.
Critical incident stress debriefing
CISD; a single 1-5 hr group meeting offered w/in three days after a diasaster.
Dissociative disorders
Once viewed as expressions of hysteria (formerly: caused by frustrated sexual desire, detached uterus; only among women until 1800s)
Jean Charcot
Used hypnosis to treat and induce hysteria. Influenced Freud and Freud's rival, Pierre Janet.
Pierre Janet
Experiments on dissociation and traied as a physician in Charcot's clinic. Saw dissoc. as abnormal vs Freud (ego defending against unaccep uncon thoughts; used dissoc interchangeably w/ repression).
A less dramatic form of dissoc wherein people feel detached from themselves/social/phys environ. Another dramatic ex is amnesia.
Psychogenic amnesia
May occur alone in w/ other dissoc experiences.
Controversial role of trauma in dissoc identity disorder (DID)
-For centuries, theorists considered dissoc and somatoform disorders as alternative forms of hysteria. Separated in DSM III. The DSM IV has 4 subtypes of dissoc disorders: dissociative fugue (sudden travel from home, confusion about iden/past), amnesia, [These first two have sudden onset and recovery] depersonal disorder (no memory loss), DID.
Dissociative Disorders
The most common form of amnesia in dissoc. is selective amnesia (often rel to traumatic exp events)
DID/Multiple Personality Disorder.
-Dispute about the assoc btwn trauma and DID. -Concerns about retrospective reports. -Diagnosis in DSM IV excluded if dissoc occurs w/ substance abuse or organic pathology.
Sociological view
Iatrogenesis: manufactor of dissoc disorders by their treatment, but diag in Turkey w/ no public awareness of disorder.
Somatoform disorders
[Typically occur w/ other psy problems, partic dep/anxiety. Freq linked to antisoc personality disorder]
Char by unus phy symtoms w/out known phy illness.
1) Conversion disorder 2) Somat disorder 3) Hypochondriasis 4) pain disorder 5) body dysmorphic disorder
-AKA Diagnosis by exclusion.
Conversion disorder
Often mimics symptoms of neurological diseases and can by dramatic. Ex. Hysterical blindness/paralysis. Make no anatomic sense.
Somatization disorder (10x likely in women)
Mult somatic complaints w/out organic impairments; at least 8 phy symptoms. May exhibit histrionic manner or la belle indifference.
pain disorder
2. body dysmorphic disorder
Preocc w/ pain. 2. Imagined defect in appearance.
Freud and somatoform disorders:
Primary gain: intol uncon psy conflicts. Sec gain: avoiding responsibility, gain sympathy. Sec gain now known as Reinforcement. Not nec due to sexual abuse.
Antidep may help.